Can I recreate this form with Jotform

4 column form fields on the 1st row and 1 full width text area on the 2nd row.

Please let me know thanks.

Yes, that is possible here in JotForm. Here's the demo form: https://form.jotformpro.com/70721291824959. You can clone the form to check it in the Form Builder. I added 5 short text field and shrink all of the field. After that, I increased the form width to 1000px. Also, I shrink the Submit button.

Here's a guide how to clone the demo form: https://www.jotform.com/help/42-How-to-Clone-an-Existing-Form-from-a-URL

Keep in mind that the design can be achieved by adding custom CSS code to your form. 

If you have questions, please contact us again. Thank you.

Hi thanks for the respond John!
But as you can see, the "Date" field is just a normal text field.
http://sydneyhairtransplant.com.au/

How can I change it to a Date field retaining the 4 columns of the form?

Thanks!

You need to add a Date Picker field to your form and remove the Date field. After that, select the Date Picker field and click the Properties icon. In the Advanced tab, enable the Shrink feature.

You will also need to increase the width of the form. Here's how:

I have updated my demo form: https://form.jotformpro.com/70721291824959. You can clone it if you want, here's a guide on: How-to-Clone-an-Existing-Form-from-a-URL

Hope that helps. Please try it and if you have questions, please contact us again.